Take
Home Message: In this randomized controlled study, researchers found that the inclusion
of platelet-rich plasma for huge rotator cuff decreased retear rate and
resulted in a slight increase in cross-sectional area of the supraspinatus a
year following surgery.

Platelet-rich plasma (PRP) is commonly
incorporated into surgical procedures to help with healing of various
tissues. However, the true effect of PRP is still largely unknown. The purpose
of this randomized controlled trial was to assess the efficacy of PRP in
patients undergoing arthroscopic repair of a large to massive rotator cuff tear
(>30mm anteroposterior size). The authors randomly assigned 48 patients
between the ages of 45 and 84 years into PRP-augmented or conventional
treatments groups. The primary outcome measure was the retear rate 1-year post
surgery. Secondary outcomes measured pre-surgery, immediately post-surgery, and
1-year post surgery included clinical outcomes (e.g., pain, range of motion,
strength) and the cross-sectional area (CSA) of the supraspinatus. At a year
post-surgery, the PRP group (20%) had a lower retear rate than the conventional
group (56%). Pain, range of motion, strength, and CSA of the supraspinatus were
not different between groups pre-surgery, immediately post-surgery, or 1-year
post-surgery. However, the PRP group reported greater improvement in function at
1-year post-surgery compared with the conventional group.

This study found that a patient who
received PRP was less likely to retear his/her rotator cuff compared with a
patient that received conventional treatment. As a clinician, this is
particularly important because no patient wants to retear the rotator cuff and
be at risk for recurrent shoulder symptoms. However, a limitation of this study
is the relatively short follow-up. One year may not be enough time to adequately
assess the use of PRP during arthroscopic repair of a large to massive rotator
cuff tear. While patients in the PRP group experienced less retears and more
self-reported function at 1 year post-surgery, both groups had comparable
clinical outcomes (e.g., pain, strength). If both groups have similar improvements
this raises an interesting question: is it worth the extra money for PRP? Unfortunately,
this study only looked at arthroscopic repairs for large to massive tears so we
cannot generalize these results to other pathologies and surgeries. But among
these patients, PRP may be beneficial in the sense of retear rates but overall,
it may not be as life-altering as we think.

Questions
for Discussion: As a clinician, what are your experiences with PRP? Besides the
retear rate, none of the clinical outcomes differed between groups; with that
said, do you believe PRP should be used in surgical procedures?

1 comments:

Although the clinical outcomes were not different between groups, the outcomes that were influenced are enough to warrant the use of PRP for this procedure, in my opinion. The test group had significantly fewer re-tears in a single year, which I think is enough to convince a patient to use the method. The process of surgery and rehabilitation are physically and emotionally taxing, and the potential of avoiding that process again seems like reasonable motivation. I'm interested to see what the longer term outcomes will be, perhaps five or ten years following the procedure, to see if the PRP affects the long term health of the tissue.PRP seems promising, and it will be interesting to see what future literature reveals. However, the biggest disadvantage to using PRP is that it is still considered to be an "experimental" procedure , which keeps it from being covered by most insurance plans (to my knowledge). More high-quality RCTs such as this will aid in removing the barrier from PRP being used more regularly in surgical procedures.

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